The per-capita U.S. expenditure for health care is twice that of the average industrialized nation, and it’s growing at an undsustainable rate. One reason for that grim reality, says a survey of doctors in the Archives of Internal Medicine, is that a considerable amount of health care is unnecessary. Patients, they say, get too much care.
You can’t read a big-city newspaper without encountering stories about people without adequate medical insurance going without medical care. But folks being overtreated? Not so much.
Nearly half of the of the 440-some respondents believe their own patients receive too much care, and just more than half believe the amount of care is just right. Nearly 3 in 10 said they were practicing more aggressive medicine than they would like.
They gave three primary reasons for their indulgent care:
- concern over malpractice lawsuits (that is, if you overtreat, accusations that your care was wanting lose their punch);
- clinical performance measures (that is, you have to “prove” your worth); and
- inadequate time to spend with patients (that is, if you don’t have time for people, give them tests and treatments to fill the void of communication).
The study concluded that “physicians are open to practicing more conservatively,” and that “physicians believe they are paid to do more and exposed to legal punishment if they do less. Reimbursement systems should encourage longer primarly care physician visits and telephone, email and nursing follow-up, rather than diagnostic intensity.”
In an accompanying commentary to the study, Dr. Calvin Chou sees “a kind of trained helplessness” in the physicians’ responses. They practice aggressively because they have no recourse.
Chou suggests that doctors address the problem through communication and by avoiding burnout.
His reflection mirrors our feelings. As far as avoiding burnout, well, we’re not career counselors, but we do understand the value of communicating with patients. Larding unnecessary tests and treatments into patient care is like giving kids expensive toys and too much sugar when you don’t have time sit down and go over their homework. It’s a replacement for time, and it’s not without side effects.
We also believe the concern about malpractice lawsuits causing defensive medicine is off target. When patients sue for not having been tested enough, it’s because a simple test was available that could have headed off the catastrophe which then occurred.
There’s no “defensive medicine” in ordering the right test, and it’s perverse to suggest that a doctor might only order a valuable test on a patient because of the threat of being sued if he doesn’t.